TRYPANOSOME OCCURRING IN THE BLOOD OF MAN 457 
General Symptoms. On examination of the patient with Dr. Forde, December 
18, 1 901, we found his temperature 100*4, pulse 96, respiration 34. 
Chief symptoms were weakness, marked loss of weight, could not walk far 
without feeling very tired. Patient did not complain of any definite symptom. There 
was no pain nor headache, but a little loss of appetite and sleeplessness at times. On 
December 16 he had a slight bleeding from the nose. There was no cough, but 
some dyspnoea on exertion. The general facial aspect which had been remarked 
upon by his friends was very striking. The face was puffy and congested. The eyes 
were sunken, the conjunctivae had a watery appearance, but were not congested ; the 
most prominent feature was the puffiness of the lower lids, which were distinctly 
oedematous. On examining the body generally one noticed that the skin appeared 
cvanotic, especially on the chest and thighs, pressure made with the hand caused a 
white mark which took some little time to disappear. There was some puffiness 
around the ankles, the skin pitting slightly on pressure ; the skin was dry ; no 
jaundice. 
Respiratory System. No cough, no expectoration. Respirations were increased 
in frequency. This frequency of the rhythm was very noticeable on the slightest 
exertion or excitement. During the time in which I observed him, his respirations 
were never below twenty per minute — the usual being from twenty-five to thirty, 
they were never laboured. Chest somewhat barrel-shaped, breath sounds normal, 
no dulness, slight emphysema, otherwise the lungs appeared healthy. 
Circulatory System. Pulse frequent 96, regular in time and force ; tension 
normal, artery normal. The pulse was always frequent, it hardly ever was recorded 
below 90 even when the temperature remained low. 
Heart. Apex in the fourth interspace four inches from the mid line. Impulse 
could be distinctly seen, not diffuse ; cardiac dulness commenced above at the third 
rib, and did not extend to the right beyond the mid sternal line ; cardiac sounds 
normal, no adventitious sounds. 
Digestive System. Appetite fair, no diarrhoea ; had to take an occasional aperient, 
no pain on abdominal palpation. 
Liver. Dulness, four-and-a-half inches in nipple line ; extended just below 
costal margin. 
Spleen. There was a slight bulging of the splenic area. Splenic dulness increased, 
diagonally measured seven inches. The edge of the spleen could be felt below the 
costal margin. There was no tenderness on palpation. 
Nervous System. Nothing abnormal could be detected. 
Lymphatic System. No definite enlargement of lymphatic glands. 
Renal System. Urine normal in quantity, rather high coloured, sp. gr. 1020, 
acid, no albumen, no casts, some phosphates. 
